Mapping Veterinary Curricula to Enhance World Organisation for Animal Health (OIE) Day 1 Competence of Veterinary Graduates.

Curriculum mapping provides a systematic approach for analyzing the conformity of an educational program with a given set of standards. The Chiang Mai University Faculty of Veterinary Medicine and the University of Minnesota College of Veterinary Medicine joined together in an educational twinning project to map their Doctor of Veterinary Medicine curricula against core competencies identified by the World Organisation for Animal Health (OIE) as critically important for Day 1 veterinary graduates to meet the needs for global public good services. Details of curriculum coverage for each specific and advanced competency were collected through a review of syllabi and course descriptions, followed by in-depth interviews of key faculty members. The depth of coverage of each competency was estimated by the tabulating the number of hours assigned. The teaching methods and levels of learning were also captured. While the overall design of the curricula conformed to the OIE Guidelines for Veterinary Education Core Curricula, the mapping process identified variability in the depth and breadth of coverage on individual competencies. Coverage of the Day 1 Specific Competencies was greater early in the curricula. More gaps existed in terms of the Advanced Competencies than the specific core competencies. Discussion of the identified gaps with faculty members led to opportunities for strengthening the curricula by adjustments of individual courses throughout the curricula. Documentation of teaching methods also led to professional development of new pedagogical skills and redesign of the teaching methods for particular subjects.

Medical Student Mock Interviews to Improve Residency Interviewing and Match Success.

PURPOSE: Using a quasi-experimental approach, we examined student and faculty satisfaction with a mock residency interview program. We also examined whether self-selected participants had match rates that differed from nonparticipants. METHODS: Interviews were arranged on a specified evening between students and a physician in the specialty to which the student wished to apply. Interviews were structured as similarly to residency interviews as possible, but included 10 minutes of verbal feedback and subsequent written feedback to all students. Students completed surveys indicating their satisfaction with the mock interview immediately following the interview and 5 months later (after their actual resident interviews). Faculty feedback to students and their satisfaction with the program also was collected. Out of 189 (55%) students in the senior class, 104 volunteered to participate. RESULTS: Immediately following the mock interview, over 90% of students who participated either strongly agreed or agreed that the interview feedback was helpful, seemed realistic, and helped them identify strengths and weaknesses. Responses collected 5 months later were still favorable, but less positive. Faculty identified 7 students who they believed had poor interview techniques and an additional 13 who interviewers believed would be unlikely to match in their specialty. Final match results for the group participating in the mock interview showed a primary match rate of 99%, which was higher than students who did not participate (94%, P < .001). CONCLUSION: In a self-selected group of students who chose to participate, mock interviews were useful in improving student match success compared to students who did not participate in the mock interview program. Because all students were not required to participate, it is unclear whether this tactic would be successful for all students.

Cost and Utilization: Hospitalized Patients on a Family Medicine Service.

OBJECTIVES: The cost of hospitalizations contributes to the rising expense of medical care in the United States. Providing health insurance to uninsured Americans is a strategy to reduce these costs, but only if costs for uninsured patients are disproportionately high. This study examined hospitalization use patterns for uninsured patients compared with those with Medicaid and commercial insurance. METHODS: We performed a retrospective chart review to analyze inpatient admissions to a family medicine teaching service in a 290-bed, for-profit community hospital during a 2-year period based on insurance status of the patient. Outcome variables investigated were length of stay, emergency department visits, and readmission rates to the hospital and/or emergency department. Secondary outcome variables were mean charges. RESULTS: A total of 1102 admissions to a family medicine teaching service were evaluated. Length of stay, readmission rates to the hospital and the emergency department after hospital discharge, and average length of stay compared with diagnosis-related groups were significantly higher in the Medicaid population than for insured and uninsured individuals. Variable costs also were significantly higher. CONCLUSIONS: Insurance status was found to be a significant factor in hospital charges and utilization data, with Medicaid patients having the highest costs. This suggests that moving uninsured patients to Medicaid may not significantly reduce hospitalization costs.

Incorporating risk communication into highly pathogenic avian influenza preparedness and response efforts.

A highly pathogenic avian influenza (HPAI) outbreak in the United States will initiate a federal emergency response effort that will consist of disease control and eradication efforts, including quarantine and movement control measures. These movement control measures will not only apply to live animals but also to animal products. However, with current egg industry "just-in-time" production practices, limited storage is available to hold eggs. As a result, stop movement orders can have significant unintended negative consequences, including severe disruptions to the food supply chain. Because stakeholders' perceptions of risk vary, waiting to initiate communication efforts until an HPAI event occurs can hinder disease control efforts, including the willingness of producers to comply with the response, and also can affect consumers' demand for the product. A public-private-academic partnership was formed to assess actual risks involved in the movement of egg industry products during an HPAI event through product specific, proactive risk assessments. The risk analysis process engaged a broad representation of stakeholders and promoted effective risk management and communication strategies before an HPAI outbreak event. This multidisciplinary team used the risk assessments in the development of the United States Department of Agriculture, Highly Pathogenic Avian Influenza Secure Egg Supply Plan, a comprehensive response plan that strives to maintain continuity of business. The collaborative approach that was used demonstrates how a proactive risk communication strategy that involves many different stakeholders can be valuable in the development of a foreign animal disease response plan and build working relationships, trust, and understanding.

The impact of holding time on the likelihood of moving internally contaminated eggs from a highly pathogenic avian influenza infected but undetected commercial table-egg layer flock.

Emergency response during a highly pathogenic avian influenza (HPAI) outbreak may involve quarantine and movement controls for poultry products such as eggs. However, such disease control measures may disrupt business continuity and impact food security, since egg production facilities often do not have sufficient capacity to store eggs for prolonged periods. We propose the incorporation of a holding time before egg movement in conjunction with targeted active surveillance as a novel approach to move eggs from flocks within a control area with a low likelihood of them being contaminated with HPAI virus. Holding time reduces the likelihood of HPAI-contaminated eggs being moved from a farm before HPAI infection is detected in the flock. We used a stochastic disease transmission model to estimate the HPAI disease prevalence, disease mortality, and fraction of internally contaminated eggs at various time points postinfection of a commercial table-egg layer flock. The transmission model results were then used in a simulation model of a targeted matrix gene real-time reverse transcriptase (RRT)-PCR testing based surveillance protocol to estimate the time to detection and the number of contaminated eggs moved under different holding times. Our simulation results indicate a significant reduction in the number of internally contaminated eggs moved from an HPAI-infected undetected flock with each additional day of holding time. Incorporation of a holding time and the use of targeted surveillance have been adopted by the U.S. Department of Agriculture in their Draft Secure Egg Supply Plan for movement of egg industry products during an HPAI outbreak.

Trends in hospitalizations with antibiotic-resistant infections: U.S., 1997-2006.

OBJECTIVES: Antibiotic resistance is a significant global problem, but the trends in prevalence and impact of antibiotic resistance in hospitalizations in the United States are unclear. We evaluated the trends in hospitalizations associated with antibiotic-resistant infections in U.S. hospitals from 1997 to 2006. METHODS: We analyzed the National Hospital Discharge Survey (NHDS) during 1997-2006 (unweighted n = 3.3 million hospitalizations; weighted n = 370.3 million hospitalizations) and examined trends in prevalence of hospitalizations with antibiotic-resistant infections, length of stay, and discharge status. RESULTS: The number of infection-related hospitalizations with antibiotic resistance increased 359% during the 10-year period, from 37,005 in 1997 to 169,985 in 2006. The steepest rise was seen among individuals < 18 years of age. The mean age of individuals with infection-related hospitalizations that had antibiotic-resistant infections decreased substantially, from 65.7 years (standard error [SE] = 2.01) in 1997 to 44.2 years (SE = 1.47) in 2006. As the proportion of patients with antibiotic-resistant infections who did not have insurance increased, the length of stay for those hospitalizations had a corresponding decrease (r = 0.91, p < 0.01). CONCLUSIONS: Antibiotic-resistant infections are becoming increasingly commonplace in hospitalizations in the U.S., with a steady upward trend between 1997 and 2006. Antibiotic-resistant infections are increasingly being seen in younger patients and those without health insurance.

Medical Student Burnout as Impacted by Trait Emotional Intelligence - Moderated by Three-Year and Four-Year Medical Degree Programs and Gender.

INTRODUCTION: Medical student burnout has received increasing attention in recent years due to greater acceptance of psychological and emotional vulnerability in the health care profession. Given the significant investment of personal and financial resources in this demanding profession, continued evaluation of factors contributing to burnout in medical training is necessary. A midwestern medical college with a longstanding 4-year medical degree program created 2 regional campuses that utilize a calendar-efficient 3-year medical degree program. The objective in this study is to examine if medical student burnout scores are higher for students on the 3-year campuses and how that is affected by emotional intelligence. METHODS: First- and second-year medical students voluntarily completed the Maslach Burnout Inventory for Students (scale: 1 = never, 7 = every day) and the Trait Emotional Intelligence Questionnaire (scale: 1 = completely disagree, 7 = completely agree). Multifactor analysis of variance assessed mean differences in burnout between campus and gender. Multivariate linear regressions were used for predicting burnout from emotional intelligence. RESULTS: Three-year campus students reported significantly (P<0.010) higher mean [SD] scores (8.3 [2.0]) than the 4-year campus students (7.4 [2.4]), and female students reported significantly (P<0.049) higher scores (8.2 [2.0]) than male students (7.6 [2.4]). Five emotional intelligence facets were independently associated with increased burnout scores (R² = 0.26, P<0.001) but significantly varied with campus and gender. CONCLUSIONS: There were higher burnout scores in students studying on the two 3-year campuses compared to students on the traditional 4-year campus and higher scores for female students than male students. Different facets of emotional intelligence mitigated student burnout by campus and gender.

Student Leadership Development Initiative: Benefits of a Unique Medical Student Organization.

BACKGROUND: The Student Leadership Development Initiative was founded at the Medical College of Wisconsin to unite local physician leaders with Medical College of Wisconsin students to develop leadership skills and prepare for careers expanding beyond clinical practice. METHODS: An anonymous survey was distributed to 246 current and past Student Leadership Development Initiative participants, probing confidence in leadership skills, professional goals, and the perceived importance of leadership training. Feedback interviews were also conducted. RESULTS: Respondents reported improvement in areas such as compassion, leadership, and development of career goals. The perceived benefit for developing professional goals and compassion are positively related (P < 0.01) to the number of sessions attended. DISCUSSION: Survey results highlight the importance of leadership training in medical education and suggest an integration strategy for a successful leadership training platform.

Vitamin D and methicillin-resistant Staphylococcus aureus nasal carriage.

Studies have found that vitamin D plays an important role in mediating immune function via a number of pathways, including enhancing the release of antimicrobial peptides in the skin. Given these findings, we hypothesize that low serum vitamin D levels may increase the risk of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA). A secondary data analysis of the National Health and Nutrition Examination Survey 2001-2004 was performed to investigate the association between serum vitamin D levels and MRSA nasal carriage for the non-institutionalized population of the USA. An estimated 2.7 million persons (1.2% of the population) are MRSA nasal carriers. An estimated 63.3 million persons (28.4% of the population) are vitamin D deficient (serum vitamin D <20 ng/ml). In an adjusted logistic regression analysis controlling for age, race, gender, poverty income ratio, current health status, hospitalization in the past 12 months, and antibiotic use in the past month, individuals with vitamin D deficiency had a statistically significant increased risk of MRSA carriage of 2.04 (95% CI 1.09-3.84). Vitamin D deficiency is associated with an increased risk of MRSA nasal carriage. Further trials may be warranted to determine whether vitamin D supplementation decreases the risk of MRSA colonization.

Post-traumatic stress disorder screening test performance in civilian primary care.

PURPOSE: we determined the test performance characteristics of four brief post-traumatic stress disorder (PTSD) screening tests in a civilian primary care setting. METHODS: this was a cross-sectional cohort study of adults attending a family medicine residency training clinic in the southeastern USA. Four hundred and eleven participants completed a structured telephone interview that followed an index clinic visit. Screening tests included: PTSD Symptom Checklist-Civilian Version (17 items), SPAN (four items), Breslau's scale (seven items) and Primary Care PTSD screen (PC-PTSD) (four items). A modified Clinician-Administered PTSD Scale was used to determine past month PTSD for comparison. Receiver operating characteristic analysis based on area under the curve (AUC) was used to assess diagnostic efficiency (>0.80 desired). Cut-off scores were selected to yield optimal sensitivity and specificity (>80%). RESULTS: past month PTSD was substantial (women = 35.8% and men = 20.0%; P < 0.01). AUC values were PTSD Symptom Checklist (PCL) (0.897), SPAN (0.806), Breslau's scale (0.886) and PC-PTSD (0.885). Optimal cut-scores yielded the following sensitivities and specificities: PCL (80.0% and 80.7%; cut-off = 43), SPAN (75.9% and 71.6%; cut-off = 3), Breslau's scale (84.5% and 76.4%; cut-off = 4) and PC-PTSD (85.1% and 82.0%; cut-off = 3). Overall and gender-specific screening test performances were explored. CONCLUSIONS: results confirm: (i) PTSD was common, especially among women; (ii) all four PTSD screening tests were diagnostically adequate; (iii) Two of four PTSD screening tests showed adequate sensitivity and specificity (>80%) and (iv) The PC-PTSD screening test (four items) appeared to be the best single screening test. There are few studies to establish the utility of PTSD screening tests within civilian primary care.

Supporting business continuity during a highly pathogenic avian influenza outbreak: a collaboration of industry, academia, and government.

Since 2006, a collaborative group of egg industry, state, federal, and academia representatives have worked to enhance preparedness in highly pathogenic avian influenza (HPAI) planning. The collaborative group has created a draft egg product movement protocol, which calls for realistic, science-based contingency plans, biosecurity assessments, commodity risk assessments, and real-time reverse transcriptase-PCR testing to support the continuity of egg operations while also preventing and eradicating an HPAI outbreak. The work done by this group serves as an example of how industry, government, and academia can work together to achieve better preparedness in the event of an animal health emergency. In addition, in the event of an HPAI outbreak in domestic poultry, U.S. consumers will be assured that their egg products come from healthy chickens.

Medical Education with 3-Year Regional Campuses: Do They Attract a Different Type of Applicant?

BACKGROUND: In response to calls to increase class sizes, the Medical College of Wisconsin (MCW) opened two new 3-year community-based regional campuses in 2016 and 2017. The goal of this study was to analyze whether the applicants and accepted student pools differed for the school's 3-year and 4-year campuses. METHODS: Deidentified data from Wisconsin applicants to MCW for the class enrolling in 2017 were categorized based on their preference for the Milwaukee or a regional campus. Applicants and admitted student data were compared on Medical College Admissions Test (MCAT) score, undergraduate school grade point average (GPA), sex, age, research intensity of their undergraduate school (Carnegie 1 classification vs all others) and Wisconsin county of residency. RESULTS: Regional campus applicants were significantly older (24.6 vs 23.7, P = 0.023), more likely to reside in nonurban counties (33% vs 13%, < 0.001), attend nonresearch-intense undergraduate schools (65% vs 44%, P < 0.001) and had lower mean MCAT scores (d=0.77, P < .001) than applicants to the Milwaukee campus. Regression models indicated 4 applicant qualities were associated with a preference for 4-year (values > 1.0) or 3-year (values < 1.0) campus: graduation from a Carnegie 1 undergraduate school (OR = 1.626; 95% CI, 1.01 - 2.62), a higher age at the time of application (OR = 1.092; 95% CI, 1.01 - 1.18), total MCAT score (OR = 0.916; 95% CI, 0.89 - 0.95), and permanent residence in a rural Wisconsin county (OR = 0.349; 95% CI, 0.21 - 0.59). When we examined students who were accepted and matriculated as opposed to just applicants, regression models showed that students with higher ages were more likely to attend the 4-year campus (OR = 1.42; 95% CI, 1.15 - 1.76), while a higher total MCAT score (OR = 0.83; 95% CI, 0.76 - 0.91) and rural county residency (OR = 0.27; 95% CI, .1 - 0.73) were associated with atriculation to the 3-year regional campuses. CONCLUSIONS: These results indicate that the regional 3-year campus model is attracting and selecting students with some differences from those at MCW's 4-year campus. After adjusting for other characteristics, students matriculating to the regional 3-year campuses are nearly 4 times more likely to come from a rural county and have slightly higher MCAT scores.

Availability of antibiotics for purchase without a prescription on the internet.

PURPOSE: Reducing inappropriate use of antibiotics is key to many antibiotic resistance initiatives. Most initiatives, however, focus almost exclusively on controlling prescribing by health care clinicians and do not focus on patient self-medication. The purpose of this study was to examine antibiotics available to patients without a prescription, a phenomenon on the Internet. METHODS: We conducted an Internet search using 2 major search engines (Google and Yahoo) with the key words "purchase antibiotics without a prescription" and "online (English only)." Vendors were compared according to the classes of antibiotics available, quantity, shipping locations, and shipping time. RESULTS: We found 138 unique vendors selling antibiotics without a prescription. Of those vendors, 36.2% sold antibiotics without a prescription, and 63.8% provided an online prescription. Penicillins were available on 94.2% of the sites, macrolides on 96.4%, fluoroquinolones on 61.6%, and cephalosporins on 56.5%. Nearly all, 98.6%, ship to the United States. The mean delivery time was 8 days, with 46.1% expecting delivery in more than 7 days. Among those selling macrolides (n = 133), 93.3% would sell azithromycin in quantities consistent with more than a single course of medication. Compared with vendors that require a medical interview, vendors who sell antibiotics without a prescription were more likely to sell quantities in excess of a single course, and the antibiotics were more likely to take more than 7 days to reach the customer. CONCLUSIONS: Antibiotics are freely available for purchase on the Internet without a prescription, a phenomenon that encourages self-medication and low quality of care.

Student Leadership Development Initiative: A Pilot for a Sustainable, Replicable Model for Incorporating Leadership into Medical Education.

INTRODUCTION: Today's medical students are tomorrow's leaders. As leadership training becomes incorporated into undergraduate medical education, there is a need for validated educational models that are both effective and replicable. METHODS: Between April 2017 and October 2017, groups of 15 to 20 medical students participated in sessions with an exemplary physician leader incorporating a guided interview format and discussion about her or his career. Prepared questions ensured leadership domains were covered. The program was evaluated using a post-session survey. RESULTS: One hundred percent of survey respondents (N = 58) reported that the session was a good use of time. Seventy-eight percent felt more prepared to lead a team; 93% learned specific ways to improve their leadership skills. DISCUSSION: This leadership program is a unique model to provide leadership education to medical students that is both effective and replicable.

Joint degree programs in public health.

Public health and veterinary medicine share a focus on population health and primary prevention, along with a commitment to preparedness, response, and recovery in the event of disease outbreaks. Public-health and veterinary professional degree programs share commonalities in their educational accreditation requirements related to epidemiology and public-health practice. The initiation of a number of joint professional degree programs over the last five years, including the joint Doctor of Veterinary Medicine and Master of Public Health (DVM/MPH), represents an exciting development for inter-professional education for veterinarians interested in public health. Various models for joint DVM/MPH educational programs are discussed, including pre-veterinary public-health credentialing, integrated programs, and post-DVM executive programs. Collaborations between colleges of veterinary medicine and schools of public health show great promise in both educational and research innovation.

The need for public-health veterinarians as seen by future employers.

Future employers of veterinarians working in public health see a fast-growing demand. Emerging zoonotic diseases, bio-security threats, and food-safety problems all require the expertise of veterinarians with a focus on complex, global problems that span both human and animal health. The Public Health Task Force of the Association of American Veterinary Medical Colleges convened a group of stakeholders representing various branches of the US federal government, state and local governments, and professional societies to discuss their needs for public-health veterinarians. This article discusses those needs, the broader societal needs that require veterinarians with public-health expertise, and the implications of these for educational programs to train DVMs in public-health issues.

A flexible approach to training veterinarians in public health: an overview and early assessment of the DVM/MPH dual-degree program at the University of Minnesota.

As a result of the growing need for public-health veterinarians, novel educational programs are essential to train future public-health professionals. The University of Minnesota School of Public Health, in collaboration with the College of Veterinary Medicine, initiated a dual DVM/MPH program in 2002. This program provides flexibility by combining distance learning and on-campus courses offered through a summer public-health institute. MPH requirements are completed through core courses, elective courses in a focus area, and an MPH project and field experience. Currently, more than 100 students representing 13 veterinary schools are enrolled in the program. The majority of initial program graduates have pursued public-practice careers upon completion of the program. Strengths of the Minnesota program design include accessibility and an environment to support multidisciplinary training. Continued assessment of program graduates will allow for evaluation and adjustment of the program in the coming years.

Recruiting faculty to perform deliveries in family medicine residencies: results of a residency program survey.

BACKGROUND AND OBJECTIVES: One factor cited for the decline of family physicians delivering babies is a lack of faculty role models during residency training. This study's purpose was to determine how many residency programs experience difficulty recruiting faculty who perform deliveries and whether financial or not financial compensation are associated with recruiting difficulties. METHODS: Using an electronic questionnaire, we surveyed program directors of nonmilitary family medicine residencies in the United States, with a response rate of 60.7%. RESULTS: Among residency programs who tried to recruit faculty with delivery skills, 58% stated that they have difficulties. Two program characteristics were associated with recruitment difficulties: the number of delivery providers among faculty and whether the residency program directors included delivery in their own practices. There were no statistically significant associations between recruiting difficulties and any type of financial reimbursement methods, but nonfinancial incentives were offered more often by programs that had no difficulty recruiting. CONCLUSIONS: More than half of all family medicine residency programs have difficulty recruiting faculty members to provide delivery training. Changing the type of financial compensation for faculty providing maternity care is not likely to assist in recruiting. However, we did find that programs without recruiting difficulties were more likely to offer nonfinancial incentives to faculty members who perform deliveries.

Science of health care delivery as a first step to advance undergraduate medical education: A multi-institutional collaboration.

Physicians must possess knowledge and skills to address the gaps facing the US health care system. Educators advocate for reform in undergraduate medical education (UME) to align competencies with the Triple Aim. In 2014, five medical schools and one state university began collaborating on these curricular gaps. The authors report a framework for the Science of Health Care Delivery (SHCD) using six domains and highlight curricular examples from each school. They describe three challenges and strategies for success in implementing SHCD curricula. This collaboration highlights the importance of multi-institutional partnerships to accelerate innovation and adaptation of curricula.

Nasal carriage of Staphylococcus aureus and methicillin-resistant S aureus in the United States, 2001-2002.

PURPOSE: Staphylococcus aureus is a common cause of invasive infections, yet most assessments of prevalence are based on health care-based samples. We computed population-based estimates of nasal carriage of S aureus and risk factors for carriage, as well as population-based estimates of nasal carriage of methicillin-resistant S aureus (MRSA). METHODS: We used the National Health and Nutrition Examination Survey (NHANES) 2001-2002 to estimate carriage of S aureus and MRSA for the non-institutionalized US population including children and adults. RESULTS: An estimated 86.9 million persons (32.40% of the population) were colonized with S aureus. The prevalence of MRSA among S aureus isolates was 2.58%, for an estimated population carriage of MRSA of 0.84% or 2.2 million persons. Among individuals with S aureus isolates, individuals aged 65 years or older had the highest MRSA prevalence (8.28%). Among all the racial/ethnic groups studied, Hispanics had the highest prevalence of colonization with S aureus but, when colonized, were less likely to have MRSA. CONCLUSIONS: This first nationally representative assessment of carriage of S aureus indicates that nearly one third of the population is currently colonized by this organism. Although the prevalence of MRSA remains low, more than 2.2 million people carry this resistant organism; thus, vigilance in promoting appropriate microbial transmission protocols should remain a priority.